|
MAGIC PERICREAM
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 09900000714
|
| Hospital Charge Code |
150680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.67
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
MAGIC PERICREAM
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 09900000714
|
| Hospital Charge Code |
150680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.67
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$4.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
MAGIC PERICREAM WITH NYSTATIN
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 09900000715
|
| Hospital Charge Code |
150679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.67
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$4.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
MAGIC PERICREAM WITH NYSTATIN
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 09900000715
|
| Hospital Charge Code |
150679
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.67
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$117.03
|
|
|
Service Code
|
NDC 10006070013
|
| Hospital Charge Code |
118625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$105.33 |
| Rate for Payer: Aetna American Axle |
$76.07
|
| Rate for Payer: Aetna Commercial |
$99.48
|
| Rate for Payer: Aetna Medicare |
$58.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.07
|
| Rate for Payer: BCBS Complete |
$46.81
|
| Rate for Payer: Cash Price |
$93.62
|
| Rate for Payer: Cofinity Commercial |
$100.65
|
| Rate for Payer: Cofinity Commercial |
$81.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.62
|
| Rate for Payer: Healthscope Commercial |
$105.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.48
|
| Rate for Payer: PHP Commercial |
$99.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.07
|
| Rate for Payer: Priority Health SBD |
$73.73
|
| Rate for Payer: UMR Bronson Commercial |
$43.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.77
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 68585000575
|
| Hospital Charge Code |
118625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 68585000575
|
| Hospital Charge Code |
118625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$117.03
|
|
|
Service Code
|
NDC 10006070013
|
| Hospital Charge Code |
118625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.49 |
| Max. Negotiated Rate |
$105.33 |
| Rate for Payer: Aetna American Axle |
$76.07
|
| Rate for Payer: Aetna Commercial |
$99.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.07
|
| Rate for Payer: Cash Price |
$93.62
|
| Rate for Payer: Cofinity Commercial |
$100.65
|
| Rate for Payer: Cofinity Commercial |
$81.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.62
|
| Rate for Payer: Healthscope Commercial |
$105.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.48
|
| Rate for Payer: PHP Commercial |
$99.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.07
|
| Rate for Payer: Priority Health SBD |
$73.73
|
| Rate for Payer: UMR Bronson Commercial |
$51.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.77
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$10.66
|
|
|
Service Code
|
NDC 00904741844
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna American Axle |
$6.93
|
| Rate for Payer: Aetna Commercial |
$9.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.93
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$9.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.06
|
| Rate for Payer: PHP Commercial |
$9.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.93
|
| Rate for Payer: Priority Health SBD |
$6.72
|
| Rate for Payer: UMR Bronson Commercial |
$4.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.00
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$10.66
|
|
|
Service Code
|
NDC 00904741844
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna American Axle |
$6.93
|
| Rate for Payer: Aetna Commercial |
$9.06
|
| Rate for Payer: Aetna Medicare |
$5.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.93
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$9.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.06
|
| Rate for Payer: PHP Commercial |
$9.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.93
|
| Rate for Payer: Priority Health SBD |
$6.72
|
| Rate for Payer: UMR Bronson Commercial |
$3.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.00
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$17.32
|
|
|
Service Code
|
NDC 71399788901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna American Axle |
$11.26
|
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: Priority Health SBD |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$7.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.99
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna American Axle |
$11.26
|
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: Priority Health SBD |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$7.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.99
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399788901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna American Axle |
$11.26
|
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: Priority Health SBD |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.99
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna American Axle |
$11.26
|
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.26
|
| Rate for Payer: Priority Health SBD |
$10.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.99
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.64
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna American Axle |
$5.62
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$4.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.62
|
| Rate for Payer: BCBS Complete |
$3.46
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna American Axle |
$5.62
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.62
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.64
|
|
|
Service Code
|
NDC 09900000148
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna American Axle |
$5.62
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.62
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.64
|
|
|
Service Code
|
NDC 09900000148
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna American Axle |
$5.62
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$4.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.62
|
| Rate for Payer: BCBS Complete |
$3.46
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.91
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.62
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.48
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 64980033990
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna American Axle |
$0.70
|
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.70
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cofinity Commercial |
$0.76
|
| Rate for Payer: Cofinity Commercial |
$0.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$0.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.92
|
| Rate for Payer: PHP Commercial |
$0.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health SBD |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$0.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.81
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$181.44
|
|
|
Service Code
|
NDC 69367027102
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.83 |
| Max. Negotiated Rate |
$163.30 |
| Rate for Payer: Aetna American Axle |
$117.94
|
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.94
|
| Rate for Payer: Cash Price |
$145.15
|
| Rate for Payer: Cofinity Commercial |
$127.01
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.15
|
| Rate for Payer: Healthscope Commercial |
$163.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.22
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.94
|
| Rate for Payer: Priority Health SBD |
$114.31
|
| Rate for Payer: UMR Bronson Commercial |
$79.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.08
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$158.40
|
|
|
Service Code
|
NDC 57896063412
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.61 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: Aetna American Axle |
$102.96
|
| Rate for Payer: Aetna Commercial |
$134.64
|
| Rate for Payer: Aetna Medicare |
$79.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.96
|
| Rate for Payer: BCBS Complete |
$63.36
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cofinity Commercial |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$136.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.72
|
| Rate for Payer: Healthscope Commercial |
$142.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.64
|
| Rate for Payer: PHP Commercial |
$134.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.96
|
| Rate for Payer: Priority Health SBD |
$99.79
|
| Rate for Payer: UMR Bronson Commercial |
$58.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.80
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$206.40
|
|
|
Service Code
|
NDC 64980033912
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.37 |
| Max. Negotiated Rate |
$185.76 |
| Rate for Payer: Aetna American Axle |
$134.16
|
| Rate for Payer: Aetna Commercial |
$175.44
|
| Rate for Payer: Aetna Medicare |
$103.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.16
|
| Rate for Payer: BCBS Complete |
$82.56
|
| Rate for Payer: Cash Price |
$165.12
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Cofinity Commercial |
$177.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.12
|
| Rate for Payer: Healthscope Commercial |
$185.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.44
|
| Rate for Payer: PHP Commercial |
$175.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.16
|
| Rate for Payer: Priority Health SBD |
$130.03
|
| Rate for Payer: UMR Bronson Commercial |
$76.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.80
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 64980033990
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna American Axle |
$0.70
|
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.70
|
| Rate for Payer: BCBS Complete |
$0.43
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cofinity Commercial |
$0.76
|
| Rate for Payer: Cofinity Commercial |
$0.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$0.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.92
|
| Rate for Payer: PHP Commercial |
$0.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health SBD |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$0.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.81
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$107.80
|
|
|
Service Code
|
NDC 64980033901
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.89 |
| Max. Negotiated Rate |
$97.02 |
| Rate for Payer: Aetna American Axle |
$70.07
|
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Aetna Medicare |
$53.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.07
|
| Rate for Payer: BCBS Complete |
$43.12
|
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Cofinity Commercial |
$75.46
|
| Rate for Payer: Cofinity Commercial |
$92.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.24
|
| Rate for Payer: Healthscope Commercial |
$97.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.63
|
| Rate for Payer: PHP Commercial |
$91.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.07
|
| Rate for Payer: Priority Health SBD |
$67.91
|
| Rate for Payer: UMR Bronson Commercial |
$39.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.85
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$158.40
|
|
|
Service Code
|
NDC 57896063412
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: Aetna American Axle |
$102.96
|
| Rate for Payer: Aetna Commercial |
$134.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.96
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cofinity Commercial |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$136.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.72
|
| Rate for Payer: Healthscope Commercial |
$142.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.64
|
| Rate for Payer: PHP Commercial |
$134.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.96
|
| Rate for Payer: Priority Health SBD |
$99.79
|
| Rate for Payer: UMR Bronson Commercial |
$69.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.80
|
|
